US health task force calls for routine screening for anxiety in adults

In a nod to the country’s pressing mental health crisis, an influential group of medical experts recommends for the first time that adults under the age of 65 be screened for anxiety.

The draft recommendations, from the US Preventive Services Task Force, are designed to help primary care physicians identify early signs of anxiety during routine care, using questionnaires and other screening tools.

Anxiety disorders are often unrecognized and insufficiently detected in primary care: A study cited by the task force found the median time to start treatment for anxiety as much as 23 years.

While the task force’s first deliberations on anxiety screening predate the coronavirus pandemic, the new guidance comes at a critical time, said task force member Lori Pbert, a clinical psychologist and professor at the Chan Medical School at the University of Massachusetts in Worcester, Massachusetts.

“Covid has taken a huge toll on Americans’ mental health,” Pbert said. “This is a priority topic due to the importance of public health, but in recent years there has clearly been a greater focus on mental health in this country.”

In April, the task force made similar recommendations to begin screening for anxiety in children and teens ages 8 to 18. The proposal announced Tuesday targets young and middle-aged adults, including those who are pregnant or postpartum, citing research showing that screening and treatment can improve anxiety symptoms in people under the age of 65.

But the guidance, somewhat surprisingly, stops recommending anxiety screening for people 65 and older.

One reason: Common symptoms of aging, such as trouble sleeping, pain, and fatigue, can also be symptoms of anxiety. The task force said there was not enough evidence to determine the accuracy of screening tools in older adults, who may not be sensitive enough to distinguish between anxiety symptoms and aging conditions.

The task force advised clinicians to use their judgment when discussing anxiety with elderly patients. the task force also reiterated a previous recommendation that adults of all ages be routinely screened for depression.

The task force, an independent panel of experts appointed by the Agency for Healthcare Research and Quality, has tremendous influence, and while the advice is not mandatory, the panel’s recommendations often change the way physicians practice medicine in the United States.

Some doctors wondered how the recommendations would play out in the real world, where mental health providers say they already can’t meet patient demand, and patients complain that they have to wait months for a therapist appointment.

“Screening is great, but with a dire labor shortage, it’s baffling unless there are plans for more clinician funding,” said Eugene Beresin, a psychiatrist at Massachusetts General Hospital and executive director of the Clay Center for Young Healthy Minds.

The global prevalence of anxiety and depression has risen 25 percent in the first year of the pandemic, the World Health Organization reported earlier this year. By the end of 2021, the WHO said: “The situation had improved somewhat, but today too many people are still unable to get the care and support they need for both pre-existing and newly developed mental illnesses. “

Anxiety, with its telltale anxiety and heartbreaking, heartbreaking, palm-sweating physical signs, can manifest itself in a number of different diagnoses, including generalized anxiety disorder, social anxiety disorder, panic disorder, and others.

Together, these make up the most common mental illness in the United States, affecting 40 million adults each year, according to the Anxiety and Depression Association of America. Treatment may include psychotherapy, especially cognitive behavioral therapy; antidepressants or anti-anxiety medications; as well as various relaxation, mindfulness and desensitization therapies, doctors said.

The panel also considered the benefits of screening patients for suicide risk, but concluded that: although suicide is a leading cause of death among adults, there is “not enough evidence that screening people without signs or symptoms will ultimately help prevent suicide.”

Still, the panel urged health care providers to use their own clinical judgment to determine whether individual patients should be screened for suicide risk.

For primary care physicians, already gripped by a “crisis” of burnout, pandemic stress and their own mental health challenges, adding another screening test to a long list of clinical tasks are burdensome.

“If primary care providers are asked to screen one more thing, we’re going to break without more resources,” said a Northern California nurse practitioner, who asked not to be named because she didn’t have permission from her clinic to speak about the matter. .

While she ticked off current requirements, such as verifying up-to-date screenings for cervical, colon and breast cancers, as well as food insecurity, domestic violence, alcohol and tobacco use, she said everything had to be packed into a 15-minute appointment. , while also treating patients with complex, chronic conditions.

“It just feels wrong when people are positive for depression or anxiety, and we don’t have the mental health support to help them,” the practitioner said.

But Mahmooda Qureshi, an internist at Massachusetts General Hospital, said extra support for patients suffering from depression or anxiety will help.

“After 2020, it’s the rare patient who isn’t anxious,” said Qureshi, noting that she now routinely asks patients, “How are you stressing?” “We’ve found that when it comes to mental health, we often don’t know if we don’t ask.”

The task force recognized the challenges of providing mental health care to everyone in need, adding that less than “half of individuals who experience mental illness will receive mental health care.”

The panel also cited “racism and structural policies” that disproportionately affect people of color. The panel noted that black patients are less likely to receive mental health services compared to other groups, and that misdiagnosis of mental illness is more common in black and Hispanic patients.

Pbert said the latest guidelines are just one step in addressing patients’ urgent mental health needs. “We hope this set of recommendations can raise awareness of the need to create greater access to mental health services across the country,” she said, as well as “highlight gaps in the evidence so that funders can provide much-needed research in these areas.” support.” .”

The proposed recommendations are open for public comment through October 17, after which the task force will consider them for final approval.

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